The Call-On-Doc Guide to Ear Infection

Ear infections, also known as otitis media, occur when there is inflammation and infection in the middle ear. The middle ear is the space behind the eardrum, and it contains the tiny bones responsible for transmitting sound vibrations to the inner ear. Additionally, it is connected to the Eustachian tube, also known as the auditory tube or pharyngotympanic tube, which is a narrow and usually closed tube that connects the middle ear to the back of the throat. Because it connects to the eardrum, it plays a crucial role in maintaining equal air pressure on both sides of the eardrum and draining any excess fluid or mucus from the ear. (3) When it comes to infections, each of these parts may play a role, with other factors including: 

• Allergies and Respiratory Infections: When exposed to either, the body's immune response kicks in, causing inflammation in the nasal passages and throat. This inflammation can extend to the Eustachian tube's openings, causing them to narrow or become blocked. As a result, the normal flow of air and fluids between the middle ear and the throat is impeded. The then trapped fluid in the middle ear becomes a breeding ground for bacteria or viruses. The swelling from the inflammation can also disrupt the tube's ability to open and equalize pressure effectively. This imbalance in pressure, along with the stagnant fluid, creates an environment where infection can take hold.
• Anatomy and Age: In young children, the Eustachian tube is shorter, more horizontal, and narrower than in adults. This makes it easier for pathogens from the throat to enter the middle ear, causing infections. As children age, the Eustachian tube gradually becomes more vertical, longer, and better able to drain fluids and maintain proper pressure. Additionally, children's immune systems are still developing, making them more susceptible to infections. While allergies, colds, sinus infections, and anatomical variations can play into adults getting ear infections, the Eustachian tube in adults has developed to the point where it does not generally support an environment conducive to infection. 
• Bacterial or Viral Infections: When an individual is exposed to bacteria or viruses, such as during a respiratory infection, these pathogens can migrate from the throat into the Eustachian tube. When infected, the tube becomes inflamed, resulting in the inability to drain fluids that may have viruses and bacteria. 
• Eustachian Tube Dysfunction: Eustachian tube dysfunction refers to a disruption in the normal functioning of the Eustachian tube, which connects the middle ear to the throat. This dysfunction can result from factors like allergies, infections, or anatomical issues. When the Eustachian tube fails to open and close properly, it affects pressure regulation and fluid drainage in the middle ear. 
• Secondhand Smoke: Smoke, in general, can contribute to the development of an ear infection due to how the body reacts to it. Exposure leads to irritation and inflammation, especially when a person breathes in the smoke in large amounts. The Eustachian tube reacts with the rest of the body, Swelling in some parts due to the irritation, and then potentially leading to particles being trapped inside. The trapped particles may carry viruses or bacteria and thus cause an infection by helping to develop the perfect environment for either. 
• Swimming and Moist Environments: Spending time in wet environments, such as swimming, can contribute to ear infections due to the moisture and trapped water in the ear canal. Water that remains in the ear after swimming or bathing can create a humid environment that softens the skin lining the ear canal. This moisture can disrupt the protective barrier of the ear canal and make it more susceptible to bacterial or fungal growth. Additionally, water itself can carry bacteria or other microorganisms into the ear, increasing the risk of infection. The combination of softened skin and the potential introduction of pathogens creates conditions conducive to the development of ear infections, commonly referred to as "swimmer's ear."

Ear infections are most commonly observed in infants and young children up to eight years old. This is due to the anatomy of their Eustachian tubes, which are shorter, more horizontal, and less developed compared to those of adults. While it is still possible to get ear infections after ages eight and above, the development of the body makes it harder for ear infections to occur as time goes on. (3)

The onset of ear infection symptoms can vary depending on the type of infection, the individual's immune response, and other factors. While in most cases, the infection will take hours to a few days, maximum, to be noticeable, there are some that can take time to develop. Here are some scenarios for both quick and gradual onset of ear infection symptoms:

Quick Onset:

• Acute Otitis Media: The infection can develop rapidly, often within a day or two. Children might wake up with sudden ear infection signs like ear pain, fever, and possible irritability. The pain can be intense and might cause crying and fussiness. While less common in older patients, ear infection symptoms in adults involving the same condition are generally easier to spot and treat due to the more advanced level of communication. 
• Otitis Externa (Swimmer's Ear): This is an infection of the outer ear canal. It can develop quickly, especially after exposure to water. Ear infection symptoms might include sudden ear pain, itching, and discomfort, usually within a day or so after water exposure. Not just caused by swimming, swimmer’s ear can also develop from heavy sweat, showering, rainwater, and in areas of high humidity. 

Gradual Onset:

• Chronic Otitis Media: In some cases, especially with chronic or recurrent middle ear infections, ear infection symptoms might develop more slowly. There could be a lingering feeling of fullness or mild discomfort in the ear, along with intermittent or mild pain. Hearing loss might be gradually noticed over time.
• Adult Ear Infections: Ear infection symptoms in adults can sometimes develop more slowly compared to children. Symptoms might start with mild discomfort, a sense of pressure, or slightly reduced hearing, and then progress to more noticeable pain and other symptoms over a period of days.

All in all, ear infection symptoms in adults versus children do not vary to any noticeable degree, making the condition easy to spot if you know what to look for. The most common ear infection signs anyone should monitor include: 

• Ear Pain: Ear pain, known as otalgia, is a hallmark symptom of ear infections. Infants and young children might indicate discomfort by tugging or pulling at their ears. Older children might complain of ear pain or discomfort inside the ear.
• Fluid Drainage: In some cases, an ear infection can cause the eardrum to rupture, leading to the drainage of fluid or pus from the ear. This drainage might be clear, yellow, or even bloody. The rupture often brings relief from the pressure buildup inside the ear.
• Hearing Problems: The presence of fluid in the middle ear can affect sound transmission, leading to temporary hearing difficulties. Children might appear to not respond to sounds as they normally would, especially softer or more distant noises.
• Fever: An ear infection can cause a fever, which might range from mild to high, depending on the severity of the infection and whether it is caused by bacteria or viruses. A fever often accompanies bacterial ear infections.
• Loss of Appetite: Infants who are experiencing ear pain might find it uncomfortable to swallow, which can make feeding more difficult. This can lead to a decreased appetite or reluctance to feed.
• Sleep Disturbances: Ear pain can be more pronounced when lying down, which can disrupt sleep. Children might have trouble falling asleep or staying asleep due to discomfort.
• Balance Issues: The inner ear plays a role in balance, and when it's affected by an infection, children and adults alike might experience mild dizziness or balance problems.

Distinguishing between an earache and an ear infection involves considering the intensity and nature of the pain, alongside other accompanying symptoms. An earache often entails a range of discomfort, including dull or sharp sensations and pressure in the ear, possibly stemming from issues like sinus problems, dental concerns, or jaw discomfort. Conversely, an ear infection typically presents with more intense and throbbing pain, often accompanied by fever, drainage of fluid or pus, temporary hearing loss, and potential irritability, especially in children. Additionally, an earache may be an indication of a light or lesser ear infection. 

• Sinus Infections: Sinus infections can cause pain and pressure around the forehead, eyes, and cheeks, which can radiate to the ears. This referred pain can mimic the symptoms of an ear infection, leading to confusion. Sinus infections might also cause congestion and post-nasal drip.
• Temporomandibular Joint (TMJ) Disorder: TMJ issues involve problems with the joint that connects the jawbone to the skull. Pain from TMJ disorders can radiate to the ears and be mistaken for an ear infection. Symptoms might include jaw pain, clicking or popping when opening the mouth, and difficulty in jaw movement.
• Dental Problems: Infections or issues with teeth, particularly those in close proximity to the ear, can lead to pain that's felt in the ear. This can be especially true for back molars or impacted wisdom teeth.
• Referred Pain: Pain from one area of the body can sometimes be felt in another. For example, pain from the throat, neck, or neck muscles can be perceived as ear pain, causing confusion in identifying the source of discomfort.
• Foreign Objects: If a foreign object becomes lodged in the ear canal, it can cause pain and discomfort similar to an ear infection. This is a common occurrence, especially in children.
• Otitis Externa (Swimmer's Ear): Otitis externa is an infection of the outer ear canal, often caused by moisture exposure. It can lead to pain, itching, and discomfort that might be mistaken for an infection of the middle ear.
• Migraine: Some types of migraines can cause referred pain, including ear pain. Migraine-related ear pain might come with other symptoms such as sensitivity to light and sound, nausea, and visual disturbances.
• Wax Buildup: Excessive earwax can lead to discomfort, mild pain, and reduced hearing. This can be mistaken for an ear infection due to similar symptoms, particularly with pain, but it's related to wax accumulation rather than infection.
• Stress or Tension: Stress and tension in the neck and shoulder muscles can cause referred pain in the ear region. This type of pain might come and go and can be confused with ear-related issues.

For medical providers, an ear infection diagnosis is easy to perform, especially when the patient can communicate and a physical observation is possible. However, in many cases, a physical observation is not necessary when symptoms like ear drainage, pain, and external swelling are noticeable. (4) Due to it coming with a more unique set of signs, medical providers like those at CallonDoc can provide an accurate diagnosis when provided with a description of the ear infection symptoms in adults and children.

Distinguishing between bacterial and viral ear infections typically requires a healthcare professional's evaluation, as the ear infection symptoms alone might not definitively determine the cause. However, there are some general patterns that might help provide some insight:

Bacterial ear infections are usually caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Bacterial infections often have more severe symptoms and might include:

• Rapid Onset: Bacterial infections can develop relatively quickly, often with intense pain and a high fever.
• Pus or Fluid Drainage: There might be yellowish or greenish pus or fluid draining from the ear if the eardrum ruptures due to the infection.
• Severe Pain: Pain associated with bacterial infections is often more intense and throbbing.
• High Fever: Bacterial infections are more likely to cause a high fever, especially in children.
• Symptoms Worsening: Symptoms might worsen within the first 48 hours.

Viral ear infections, such as those caused by respiratory viruses, can lead to conditions like acute otitis media with viral upper respiratory infections. Viral ear infections might have milder symptoms:

• Gradual Onset: Viral infections might develop more gradually, with milder pain and discomfort.
• Less Fluid Drainage: Viral infections are less likely to cause significant pus or fluid drainage from the ear.
• Milder Pain: Pain from viral infections might be less severe and more dull.
• Mild to Moderate Fever: Viral infections might cause a mild to moderate fever.
• Symptoms Improve with Time: Symptoms might improve as the viral infection runs its course.

In the case that it does not resolve itself after three days and continues to get worse, ear infection treatment includes a wealth of antibiotic treatments alongside steps you can take to ensure it gets better. For both middle ear infections and outer ear infections, the steps go as follows: 

Middle Ear Infections (Otitis Media):

• Pain Management: Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage pain and reduce fever.
• Antibiotics: If the ear infection is bacterial and the symptoms are moderate to severe, the doctor might prescribe antibiotics. Amoxicillin is commonly prescribed for bacterial ear infections. It's important to complete the full course of antibiotics even if symptoms improve.
• Warm Compress: Applying a warm, moist cloth to the affected ear might help alleviate pain and discomfort.
• Tympanostomy Tubes (for Recurrent Infections): In cases of frequent or chronic ear infections, especially in children, the doctor might recommend placing tiny tubes in the eardrums to help equalize pressure and reduce the risk of future infections.

Outer Ear Infections (Otitis Externa or Swimmer's Ear):

• Pain Relief: Over-the-counter pain relievers can help manage pain and discomfort.
• Topical Ear Drops: Antibiotic or antifungal ear drops are often prescribed to treat bacterial or fungal infections of the outer ear.
• Ear Cleaning: Gently cleaning the ear canal and keeping it dry can aid in the healing process.
• Avoid Water Exposure: If you have swimmer's ear, avoiding water exposure and using earplugs while swimming or showering can help prevent moisture from exacerbating the infection.

It’s important to stress that most ear infections tend to resolve themselves within a week’s time, with those having minor or reduced symptoms generally getting the wait-and-see approach before ear infection treatment is attempted. In the event that symptoms progressively get worse and remain noticeable for more than a few days, antibiotics prescribed by a doctor would then be the next approach. 

The type of ear infection antibiotics used in treatment partly depends on the infection itself, with key differentiators including whether it's in the ear canal or nearer to the surface, symptoms exhibited, and the severity it may be at. CallonDoc offers a number of effective options on our ear infection antibiotics list, including: 

• Amoxicillin: Belonging to the class of antibiotics known as penicillins, Amoxicillin is an oral medication that works by interfering with the bacteria's ability to build their cell walls, which are essential for their survival and reproduction. Additionally, it helps to reduce the inflammation and discomfort associated with the infection and promotes the body's natural immune response in fighting off the bacteria. The medication is especially effective when ear infection symptoms are moderate to severe. (6)
• Augmentin: A combination medication that includes amoxicillin and clavulanic acid. Augmentin is an oral medication commonly prescribed to treat various bacterial infections. Enhancing amoxicillin’s ability to destroy bacteria cell walls, clavulanic acid enhances the combined ingredient by inhibiting bacterial enzymes that can potentially deactivate amoxicillin. On top of devastating targeted bacteria, the ear infection treatment reduces symptoms like pain and fever while boosting the body’s immune response. (7)
• Azithromycin: An oral antibiotic medication from the macrolide class often used to treat a variety of bacterial infections. It works by inhibiting the growth and reproduction of bacteria, ultimately leading to their elimination. Additionally, azithromycin helps to reduce inflammation, pain, and other symptoms associated with the infection. (8)
• Cefdinir: An oral antibiotic medication belonging to the cephalosporin class, commonly used to treat bacterial infections. As ear infection treatment, cefdinir works by interfering with the bacteria's cell wall synthesis, leading to their destruction. Through its ability to eliminate the bacteria, ear infection symptoms reduce and subside over time. (9)
• Ciprodex Drop: Ciprodex drops are a prescription medication that combines two active ingredients: ciprofloxacin, an antibiotic, and dexamethasone, a corticosteroid. These drops are primarily used to treat bacterial infections of the outer ear. Ciprofloxacin targets and eliminates the bacteria causing the infection, while dexamethasone helps reduce inflammation and discomfort. The combination of an antibiotic and a corticosteroid makes Ciprodex effective in addressing both the infection and the associated swelling. It's applied directly into the ear canal to provide localized ear infection treatment. (10)
• Neomycin-polymyxin: Neomycin-polymyxin is a combination of two antibiotics, neomycin and polymyxin B, often used in the form of ear drops to treat bacterial infections of the outer ear. Neomycin and polymyxin B work together to target and eliminate certain types of bacteria that cause infections in the ear canal.  Neomycin interferes with bacterial protein synthesis, disrupting their growth, while polymyxin B damages the bacterial cell membranes. These drops help fight the infection and alleviate symptoms like pain, redness, and swelling. Neomycin-polymyxin ear drops are applied directly into the ear canal for localized treatment. (11)
• Ofloxacin Otic: Ofloxacin otic is a prescription medication used to treat bacterial infections of the outer ear. It is an ear drop solution containing ofloxacin, which is a fluoroquinolone antibiotic. Ofloxacin works by inhibiting the growth and reproduction of bacteria, ultimately leading to their elimination. When applied directly into the ear canal, ofloxacin otic targets the bacteria causing the infection and helps alleviate symptoms like pain, inflammation, and discomfort. (12)

When it comes to a bacterial infection, it is important to use the ear infection antibiotics as directed. Cutting them off too early, even if you feel no symptoms and truly believe the bacteria is wiped from your system, there is a possibility that it is not. Stopping too early or regularly taking the medication outside of what is directed might cause the infection to get worse or become immune to that specific antibiotic. 

The ear may need some time to fully recover even after the ear infection treatment proves successful. While the infection itself may have been addressed with ear infection antibiotics or other medications, the tissues within the ear, particularly the middle ear, can still be affected and inflamed. Some steps you can take toward recovery include: 

• Resolution of Inflammation: Even after the infection is cleared, there might still be some inflammation and residual fluid in the middle ear. This inflammation can take some time to subside.
• Restoring Hearing: If the infection leads to hearing impairment, it might take a little while for your hearing to return to its normal level as the fluid in the middle ear dissipates.
• Monitoring: In some cases, especially if you've had recurrent or chronic ear infections, your healthcare provider might want to monitor your ear health to ensure that the infection has completely resolved.
• Preventing Future Infections: If you're prone to ear infections, your doctor might recommend preventive measures, such as keeping the ears dry, avoiding irritants, or considering the placement of tympanostomy tubes in cases of chronic infections.

While it's not always possible to prevent every ear infection, there are steps you can take to reduce the risk of developing one, especially in cases of recurrent infections or when you're prone to ear infections:

• Keep Ears Dry: Excess moisture in the ear can create a conducive environment for bacterial or fungal growth. After swimming or showering, gently tilt your head to each side to help water drain out. You can also use a clean, dry towel to pat your ears dry.
• Avoid Irritants: Avoid inserting objects like cotton swabs, paper clips, or fingers into the ear canal. These can push wax deeper into the ear, irritate the delicate ear tissues, and potentially introduce bacteria or cause injury.
• Swimmer's Ear Prevention: If you're prone to swimmer's ear, use earplugs made for swimming to prevent water from entering the ear canal. After swimming, consider using over-the-counter drying drops specifically designed to remove excess moisture from the ear.
• Manage Allergies: Allergies can lead to Eustachian tube dysfunction, which can contribute to middle ear infections. Managing allergies with appropriate medications, avoiding allergens, and consulting an allergist if necessary can help reduce the risk. CallonDoc offers effective options for allergy management and treatment to help you or your child prevent future ear infections. 
• Quit Smoking: If you smoke, consider quitting, as smoking is associated with an increased risk of ear infections, particularly in children. Secondhand smoke exposure should also be minimized. CallonDoc has developed a highly rated smoking cessation program for those needing additional assistance quitting tobacco products. 
• Proper Hygiene: Practicing good hygiene can help prevent the spread of infections from the throat or upper respiratory tract to the ears. Teach children to cover their mouths when coughing or sneezing and to wash their hands frequently.
• Treat Colds and Allergies: Promptly treat colds, sinus infections, and allergies. These conditions can contribute to Eustachian tube dysfunction, which can increase the risk of middle ear infections.
• Treat Reflux: Gastroesophageal reflux disease (GERD) can lead to Eustachian tube dysfunction. If you have GERD, managing it through lifestyle changes, diet adjustments, and medications can help prevent related ear issues. 
• Breastfeeding: If you have a baby, consider breastfeeding. Breast milk contains antibodies that can help protect against infections, including ear infections.

Whether it's by treating related conditions or getting direct ear infection treatment, CallonDoc has a number of solutions for you and your family. We offer fast relief through same-day doctor’s appointments and prescription delivery, all through our specially designed process that can be entirely undertaken through your phone in the comfort of your own home!

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2. Ren, Yin et al. “Acute Otitis Media and Associated Complications in United States Emergency Departments.” Otology & neurotology: Official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology vol. 39,8 (2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097248/. 
3. “Ear Infection (Otitis Media): Symptoms, Causes & Treatment.” Cleveland Clinic, 6 June 2023, https://my.clevelandclinic.org/health/diseases/8613-ear-infection-otitis-media.
4. “Ear infection (middle ear) - Diagnosis & treatment.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/ear-infections/diagnosis-treatment/drc-20351622. 
5. “Ear Infection | Antibiotic Use.” CDC, https://www.cdc.gov/ear-infection/about/index.html.
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9. “Cefdinir.” MedlinePlus, 15 June 2016, https://medlineplus.gov/druginfo/meds/a698001.html.
10. “Ciprodex Otic (Ear): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing.” WebMD, https://www.webmd.com/drugs/2/drug-76594/ciprodex-otic-ear/details.
11. “Neomycin, Polymyxin, and Hydrocortisone Otic.” MedlinePlus, 15 June 2018, https://medlineplus.gov/druginfo/meds/a618031.html.
12. “Ofloxacin Otic.” MedlinePlus, 15 August 2016, https://medlineplus.gov/druginfo/meds/a607011.html.